Provider Demographics
NPI:1265151070
Name:AWAL, MANU
Entity type:Individual
Prefix:
First Name:MANU
Middle Name:
Last Name:AWAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28115 WILDWIND RD
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-1276
Mailing Address - Country:US
Mailing Address - Phone:661-487-2803
Mailing Address - Fax:
Practice Address - Street 1:28115 WILDWIND RD
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-1276
Practice Address - Country:US
Practice Address - Phone:661-487-2803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021790163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse